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You know what CCM is, why aren’t you doing it?

In January of 2015, CMS initiated a new code for managing Chronic Care patients. (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1516.pdf),
(https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf).
The code could be used when following patients with two or more chronic diseases from a rather extensive list of conditions we all know lead to higher medical care costs, and many which have significant morbidity and mortality associated with them. As you may know, identifying these patients and then providing follow up contact at a minimum of 20 minutes per month can result in reimbursement for the provider of roughly $40…which Medicare pays 80% of and the practice collects 20% from the patient. Of course the individual providing that 20 minutes needs to be part of the practice (employee or contractor), and the patient needs to agree to enroll in this service which is based on his/her plan of care. There are other requirements that are spelled out in the documents listed at the beginning of this Blog. It has been over a year, and yet only a few medical practices are offering this service, and only a very few members of ACCP are actually providing CCM. In a number of cases the service has been ‘assigned’ to the office nurse (read: Medical Assistant, or RN ‘chronic care coordinator,’ social worker, dietitian) or some other practitioner rather than the pharmacist. Indeed there are even commercial services that have sprung up to outsource this service.

ACCP rallies around the possibility of reimbursement for “Comprehensive Medication Management,” yet we have not been fighting tooth and nail for “Chronic Care Management” to be our responsibility. Indeed CCM is the low hanging fruit that could potentially lead to CMM. Nowhere will pharmacists be more valuable than the chronic care patient with multiple medications. It is a gateway to MTM (at least one of them) which has been recognized as valuable by CMS and worthy of extension to more and more patients as the provision of MTM was way less than CMS had planned yet was every bit a valuable as they knew it would be. Yes, a nurse can call patients and talk to them for 20 minutes. But having access to de facto risk stratified patients who are on multiple medications, often with conditions that have documented value via telemedicine follow-up is a gift that has been sitting under our Christmas Tree for over a year. Few ACCP members have taken up the gauntlet to ‘manage’ these patients. You can download blood glucose meters remotely, you can have patients monitor their blood pressure at home (a better way to do it anyway), you can monitor and reinforce medication adherence, or even find out patients who should be on certain medications (‘statins, ACE Inhibitors) yet somehow are not. There is even recognition that CCM services need to be expanded to increase reimbursement for more complicated patients, which means that reimbursement for those patients will be even higher in the future. Reimbursement for Diabetes Education was increased due to recognition of its value, MTM was expanded due to recognition of its value, Chronic Care Management was initiated and will likely soon be expanded due to recognition of its value (http://www.nachc.com/client/SFC%20Workgroup%20Options%20Paper%2012.15.pdf) [See:policy under consideration, pg 11].

The segue between CCM and the ‘holy grail’ of Comprehensive Medication Management seems obvious, and just needs to be fleshed out. Having clinical pharmacists involved in the first will more likely lead to the latter if we decide to make it so. So let’s get crackin’